Temporal Increase In Incidence Research Articles

Trends in incidence and clinical outcome of non-ST elevation myocardial infarction in patients with amyloidosis in the United States, 2010–2020

Study objectiveTo assess temporal changes in clinical profile and in-hospital outcome of patients with amyloidosis presenting with non-ST elevation myocardial infarction, NSTEMI. Design/settingWe conducted a retrospective observational study using the National Inpatient Sample (NIS) database from January 1, 2010, to December 31, 2020. Main outcomesPrimary outcome of interest was trend in adjusted in-hospital mortality in patients with amyloidosis presenting with NSTEMI from 2010 to 2020. Our secondary outcomes were trend in rate of coronary revascularization, and trend in duration of hospitalization. ResultsWe identified 272,896 hospitalizations for amyloidosis. There was a temporal increase in incidence of NSTEMI among patients aged 18-44 years from 15.5 % to 28.0 %, a reverse trend was observed in 45–64 years: 22.1 % to 17.7 %, p = 0.043. There was no statistically significant difference in rate of coronary revascularization from 2010 to 2020; 16.3 % to 14.2 %, p = 0.86. We observed an increased odds of all-cause in-hospital mortality in patients with NSTEMI compared to those without NSTEMI (aOR = 2.2, 95 % CI: 1.9–2.6, p < 0.001) but there was a decrease trend in mortality from 21.5 % to 11.3 %, p = 0.013 for trend. Hospitalization duration was also observed to decreased from 14.1 days to 10.9 days during the study period (p = 0.055 for trend). ConclusionIn patients with amyloidosis presenting with NSTEMI, there was increased incidence of NSTEMI among young adults, a steady trend in coronary revascularization, and a decreasing trend of adjusted all-cause in-hospital mortality and length of hospitalization from 2010 to 2020 in the United States.

Antrodia Camphorata Supplement in the Early Life Inhibits Intestinal Tumorigenesis Later in Young Adult APC1638N Mice

ObjectivesColorectal cancer (CRC) is a critical burden in the U.S. with a temporal increase in incidence in young adults. Evidence shows that early-life events greatly contribute to the development of CRC, particularly early-life nutrition. Recently, a limited number of studies showed that mushroom Antrodia camphorate (AC) possesses promising health-promoting effects such as anti-inflammation and anti-tumorigenesis. The present study aims to investigate the effects of the addition of AC into a high-fat diet during early life on the development of intestinal tumorigenesis in young adult APC1638N mice. MethodsMice (4 weeks of age) were fed a low-fat diet (N = 10; LFD: 10% kcal from fat) or a high-fat diet (N = 11; HFD: 60% kcal from fat) or their combinations with AC (N = 12 for each; AC: 90 mg/kg) from 4 to 12 weeks of age equivalent to childhood and adolescence in humans. After that, all groups were switched to standard chow diet (LabDiet 5P76) and fed for additional 12 weeks before sacrifice at 24 weeks of age equivalent to young adult in humans. Tumor incidences and sizes were recorded during the dissection after sacrifice. The expressions of a panel of inflammatory mediators, insulin-like growth factor-1 (IGF-1) signaling, as well as tumorigenic Wnt-signaling in the intestine were assessed. ResultsBody weight in HFD groups significantly increased after 8 weeks feeding than in LFD groups (p < 0.05), but AC supplement did not result in significant body weight change. After switching to chow diet for additional 12 weeks, the body weight remained higher but with a reduced degree of magnitude. Regardless LF or HF, AC supplement suppressed tumor incidence and multiplicity with a significance shown for female mice (p < 0.05). The addition of AC decreased gene expressions of inflammatory mediators (Tnf-α, IL-6, IL-10, Cox-2, and CCL2), IGF1, IGF1 receptor and cMyc in the intestine (p < 0.05). At protein level, AC supplement significantly attenuated the expression of phospho-MEK and phospho-ERK1/2 in the IGF-1 signaling and phosph-GSK-3β and β-catenin in the Wnt-signaling in the intestine of mice fed with HFD (p < 0.05). ConclusionsAC supplement during the early life exhibits potential capabilities to inhibit intestinal tumorigenesis at the young adult in mice, and the effects are particularly evident for mice fed a HFD in early life. Funding SourcesUS Department of Agriculture Hatch funding.

40 Years of Change in Age- and Stage-Specific Cancer Incidence Rates in US Women and Men.

BackgroundStudies have documented a temporal increase in incidence for several cancers in US young adults aged 25 to 39-years, including noncardia gastric cancer, colorectal cancer, and distant-stage breast cancer. To further characterize trends in young adults, we assessed age-specific and stage-specific incidence trends from 1975 to 2015, overall (all malignant cancers combined), and for 18 and 16 cancer sites in women and men, respectively.MethodsWe used US population-based data from the Surveillance, Epidemiology, and End Results Program to obtain overall and site-specific cancer incidence rates by sex and age group. We individually analyzed cancer sites with an incidence rate of at least 5 per 100 000 in 2015, accounting for greater than 90% of all cancer diagnoses. We estimated annual percent changes (APCs) using segment log-linear regression performed with joinpoint software; multiple permutation testing was used to identify inflection points. We forecasted overall cancer incidence through 2030 using age-period-cohort regression models.ResultsBased on trends occurring after the most recent joinpoint inflection point, overall cancer incidence increased by 1.15% (95% CI = 1.01% to 1.28%) per year in 25- to 39-year-old women and by 0.46% (95% CI = 0.17% to 0.75%) per year in 25- to 39-year-old men; APCs were of much lower magnitude in the older age groups (eg, 70- to 84-year-old women APC = −0.31%, 95% CI = −0.42% to −0.20%). We forecasted that overall cancer incidence will increase by an additional 11% by 2030 in 25- to 39-year-old women, and by an additional 12% in 25- to 39-year-old men. Ten of the 18 cancers assessed in 25- to 39-year-old women and 7 of the 16 cancers in 25- to 39-year-old men have been statistically significantly increasing over time. We found that the increase in incidence for young adults is stage specific for some cancers (eg, only nonlocalized breast cancer has increased in 25- to 39-year-old women).ConclusionCancer incidence is increasing in young adults, particularly in young women.

Cardiac Implantable Electronic Devices in Adults with Tetralogy of Fallot

Patient with repaired tetralogy of Fallot (TOF) sometimes require cardiac implantable electronic devices (CIED) for tachy/bradyarrhythmias. There are no population-based studies of CIED-related outcomes in the adult TOF population. We reviewed the Nationwide/National Inpatient Sample to determine trends in CIED-related admissions in adults with TOF repair. This is a retrospective review of the Nationwide/National Inpatient Sample database from January 1, 2000 to December 31, 2014. There were 18,353 admissions in adults with TOF diagnosis, and of these, CIED were implanted in 792 (4.3%) admissions (CIED-related admissions). Of these 792 CIED-related admissions, pacemakers were implanted in 242 (30.7%) yielding an incidence of 1.3% and implantable cardioverter-defibrillators were implanted in 550 (69.4%) yielding an incidence of 3.0%. In-hospital mortality occurred in 14 (1.8%) of the CIED-related admissions. The mean hospital length of stay was 7.7 ± 1.3 days and inflation-adjusted hospitalization cost was $141,860 ± $127,516. In 5-year intervals (2000 to 2004, 2005 to 2009, and 2010 to 2014), there was a temporal increase in the incidence of CIED-related admissions (3.7% vs 4.4% vs 4.9%, p = 0.006). There was a similar trend in the age at the time of implantation (37.7 ± 14.2 vs 38.2 ± 13.1 vs 39.0 ± 14.5 years, p < 0.001) and Charlson Comorbidity Index (1.1 ± 1.4 vs 1.4 ± 1.8 vs 1.3 ± 1.7, p < 0.001). In conclusion, the incidence of CIED-related admissions was 4.3% and increased over time. Further studies are required to determine if the observed temporal increase in incidence of CIED implantations (particularly implantable cardioverter-defibrillators) is associated with a concomitant increase in incidence of aborted sudden cardiac death.

Trends and Outcomes of Infective Endocarditis in Adults With Tetralogy of Fallot: A Review of the National Inpatient Sample Database

BackgroundLesion complexity and prosthetic valves are known risk factors for infective endocarditis in patients with congenital heart disease. Tetralogy of Fallot (TOF) is the most common complex/cyanotic congenital heart disease and often requires prosthetic valve implantation. Population-based risk of endocarditis in TOF patients is unknown. MethodsWe reviewed the National Inpatient Sample (NIS) and identified admissions in TOF patients (>18 years), 2000 to 2014. The primary outcome was to describe incidence of endocarditis-related admissions. To assess trends, we divided the study period into tertiles: early (2000 to 2004), mid (2005 to 2009) and late (2010 to 2014) eras. The secondary outcome was to compare in-hospital mortality, complications, and health care resource utilization between admissions with and without endocarditis. ResultsThere were 393 (2.1%) endocarditis-related admissions among 18,353 admissions, and the incidence of endocarditis-related admissions increased over time: 1.9% (early era) vs 2.2% (mid-era) vs 2.4% (late era), P < 0.001. Overall in-hospital mortality was 6%. In addition to previously described risk factors for endocarditis, such as previous pacemaker/defibrillator or prosthetic valve implantation, we observed an association between endocarditis-related admissions and male gender, black race, and lower socioeconomic class. In comparison with admissions without endocarditis, the endocarditis-related admissions had higher in-hospital mortality, complications, and health care resource utilization measured by length of stay, inflation-adjusted hospitalization cost, and type of hospital discharge. ConclusionsIncidence of endocarditis-related admissions increased over time and was associated with higher mortality, complications, and health care resource utilization. Further studies are required to investigate the observed temporal increase in incidence of endocarditis and explore new strategies to improve outcomes.

Childhood nephroblastoma in Southern and Eastern Europe and the US: Incidence variations and temporal trends by human development index

BackgroundDespite advances in the management of nephroblastoma (Wilms’ tumor, WT), the etiology of the tumor remains obscure. We aimed to compare nephroblastoma incidence rates and time trends among children (0–14 years) in 12 Southern and Eastern European (SEE) countries and the Surveillance, Epidemiology, and End Results Program (SEER), USA, in relation to the human development index (HDI). MethodsIn total 1776 WT cases were recorded in 13 SEE collaborating registries (circa 1990–2016), whereas data on 2260 cases (1990–2012) were extracted from the SEER database. Age-standardized incidence rates (AIRs) were calculated and correlated with HDI, whereas temporal trends were evaluated using Poisson regression and Joinpoint analyses. ResultsThe overall SEE AIR (9.2/106) was marginally higher than that of the SEER (8.3/106), whereas significant differences were noted among the 13 SEE registries which comprised mainly Caucasian populations. A statistically significant temporal increase in incidence was noted only in Belarus. Most cases (∼75%) were diagnosed before the fifth year of life, with rates steadily declining thereafter; median age at diagnosis was similar in SEE countries and SEER. A slight male preponderance in the first year of life (male:female = 1.1) was followed by a female preponderance in the older age groups (male:female = 0.7). Lastly, a statistically significant positive association between higher HDI and increasing nephroblastoma incidence was noted (regression coefficient: +3.25, 95%CI: +1.35, +5.15). ConclusionsVariations in incidence and time trends across the examined registries, changing male-to-female patterns with advancement in age, and positive associations with the HDI imply a plausible role for environmental and genetic factors in disease etiology, and these need to be explored further.

Population Based Incidence and Age Distribution of Spermatocytic Seminoma

Spermatocytic seminoma is a rare subtype of testicular germ cell tumor which has been reported to occur in elderly men. We report the first population based estimate of incidence, temporal trends and age distribution of this tumor. All cases of primary testicular cancer identified by cancer registries in Australia between 1982 and 2002 were available for analysis. The International Classification of Diseases for Oncology code M-9063/3 was used to identify spermatocytic seminomas. Incidence trends were modeled using Poisson regression. There were 58 cases of spermatocytic seminoma out of 9,658 cases of primary malignant testicular neoplasms identified by the cancer registries. This tumor comprised 1.1% of all seminoma and the age standardized incidence rate was 0.4 per million (95% CI 0.3-0.6). A temporal increase in incidence was found but not one reaching statistically significance. Age at diagnosis ranged from 19 to 92 years with a mean of 53.5 (SD 16.7) and a median of 54 years. Spermatocytic seminoma should be considered in the differential diagnosis for testicular germ cell tumors presenting in young adults because this tumor occurs as often in men younger than 55 years as it does in older men. Although rare, the occurrence of this tumor is not as singular as the current literature suggests.

Gastric carcinoids: a temporal increase with proton pump introduction

Recent reports have indicated a rising incidence of gastric carcinoids. This study aimed to evaluate the incidence pattern of gastric carcinoids in two large population-based cancer registries. The Florida Cancer Data System (FCDS), Florida's statewide cancer registry, and the Surveillance, Epidemiology, and End Results (SEER) program were used. The study population was defined as all cases of gastric carcinoid identified in either database from January 1981 to December 2000. Descriptive statistics and age-adjusted incidence rates were calculated. There were 326 (FCDS) and 594 (SEER) cases of invasive gastric carcinoid during the 20-year study period. The mean age of the patients was 65 years (range, 21-96 years), and the male:female ratio was 1:1. The age-adjusted incidence rate in FCDS increased from 0.04 (per 100,000 age-adjusted to the 2000 U.S. standard population) to 0.18 in the year 2000. The estimated annual percentage change in incidence was 8.17 in FCDS and 9.17 in SEER (p < 0.05). A decrease in gastric cancer was noted during this same period (from 8.64 to 11.14 cases per 100,000 in FCDS and from 11.14 to 8.06 cases per 100,000 in SEER). This study documented a statistically significant eight- or ninefold increase in the incidence of gastric carcinoids in two large databases. The temporal increase in incidence correlates with the introduction and widespread use of proton pump inhibitors since the late 1980s. Other explanations include improved detection with wider application of upper endoscopy. Further epidemiologic studies are warranted.

Incidence of fractures in a geographically defined population.

The aim was to describe the population based age and sex specific incidence of fractures at different sites in a large English health district. Recording of fractures was accomplished by a specially constructed outpatient index and by record linkage to hospital inpatient information, for the three years surrounding the 1981 census. The fracture index was held by the Department of Community Health in Leicester using data from the fracture clinic at the central large district general hospital, supplemented by hospital inpatient data from Trent Region and the two adjoining regions. The denominator population was the Leicestershire Health Authority resident population. In the three years, 12,711 fractures amongst males and 10,565 amongst females were recorded. The overall estimated annual incidence of fractures was 100 per 10,000 population for males and 81 per 10,000 population for females. Below the age of 55 years all fractures showed a higher incidence amongst males but amongst the over 55s, there was a consistent fall in the male:female incidence ratio with some sites showing a striking female preponderance. The results also show an apparent age specific temporal increase in incidence at certain fracture sites compared with earlier British data, but fracture incidence figures still suggest lower rates in this country than in North America and some Scandinavian countries. These findings provide population based incidence data on a major public health problem and are consistent with the major determinants of osteoporosis and increase in falls in postmenopausal women. The temporal and geographical variation in fracture incidence remain to be explained.

Incidence of Type 1 (insulin-dependent) diabetes mellitus in subjects 0–14 years of age in the Comunidad of Madrid, Spain

A retrospective, population-based registry was established in the Comunidad of Madrid, Spain (total population: 4,780,572; under age 15: 1,105,243) to investigate the epidemiology of Type 1 (insulin-dependent) diabetes mellitus. Included were all cases diagnosed with diabetes between 1985 and 1988, with age onset less than 15 years, and using insulin at discharge from hospital. Using the capture-recapture method employing hospital records as the primary source and membership files of the Spanish Diabetic Association as the secondary source, the ascertainment was 90%. The overall annual incidence was estimated to be 11.3/100,000 (Poison 95% confidence interval: 10.3-12.4). There was no temporal increase in incidence, nor was there a significant sex difference in incidence rates, either overall or by year. The seasonal onset pattern showed the highest incidence in winter (December-February) and lowest in summer (June-August) (r = 7.36, p less than 0.05). The age-adjusted (world standard) incidence of 10.9/100,000 was inconsistent with the hypothesis of a north-south gradient in diabetes risk.